Department of Anesthesiology - Residency Program - Neuroanesthesia Rotation

The neuroanesthesia rotation is based at the University Hospital and lasts for one or two months. While most of the rotation is OR-based, additional learning opportunities include patients undergoing neurodiagnostic procedures such as CT, MRI, or angiography.

Conjoined twins under GA for CT scanWe have a very active neurosurgery program so there are many opportunities to evaluate and manage patients undergoing a broad range of neurosurgical procedures including intracranial tumor resections, intracranial and extracranial vascular procedures, stereotactic procedures, functional surgery, neurodiagnostic and interventional procedures, and a range of spine procedures. Residents learn risk factors related to neurosurgery, the relative urgency of various neurosurgical conditions and procedures, and indications and techniques for invasive monitoring including specialized techniques such as ECG-guided CVP placement .

Additionally, residents learn applications of specialized monitoring such as EEG, MEP, and SSEP, physiology of the CNS in health, disease, and in response to anesthetic agents, and medical team skills including communication.

Upon completion of the neuroanesthesia rotation, our residents:

  • Understand anatomy of the CNS.

  • Understand physiology of the CNS and spinal cord including factors of ICP and intracranial compliance; CPP; cerebral blood flow (normal values, lower limit for ischemia, autoregulation, and intracerebral steal); cerebrospinal fluid (volume, composition, circulation pathway, and hydrocephalus).

  • Understand the pathophysiology of neurological disease including intracranial mass, intracranial hemorrhage, spinal lesions, autonomic hyperreflexia, and myasthenia.

  • Understand common neurosurgical procedures.

  • Understand surgical needs related to various neurosurgical procedures including optimal timing for the procedure, special positioning and risks (prone, lateral, park bench, sitting, etc); special physiologic techniques (hypothermia, hypotension, hypertension, etc); specialized monitoring (EEG, SSEP, EMG, etc); special anesthetic techniques (awake, wake-up testing, burst suppression, barbiturate coma, etc.).

  • Identify factors related to perioperative complications in patients undergoing neurosurgical procedures.

  • Recognize complex conditions that require the patient receive specialized monitoring devices or specialized anesthetic techniques.

  • Understand the CNS pharmacology of various anesthetic and therapeutic agents including effects on ICP, CBF, EEG, SSEP.

  • Understand risks, benefits, and complications of neurodiagnostic and neuro-interventional procedures performed in patients with neurologic diseases.

Richard L. Applegate II, MD directs this rotation.